听骨赝复物在慢性中耳乳突炎Ⅰ期鼓室成形术中的应用

慢性中耳乳突炎病人听力减退的原因除鼓膜穿孔外,多伴有听小骨的破坏和缺失.为提高中耳炎患者术后听力,本院自1998年即开展Ⅰ期鼓室成形术,取得了一定疗效.现对自2002年1月至2004年5月,采用自体听骨或人工听骨植入施行Ⅰ期开放式鼓室成形术的病例96例(均为单耳),进行了随访研究,报告如下.     

颈椎前路手术后邻近节段运动变化的生物力学研究

目的利用压敏片(PSF)技术,测量颈椎前路手术后关节突关节内压力的变化,探讨颈前路手术后远期邻近节段退变的生物力学发病机制。方法10具新鲜成人颈椎尸体标本(C2～T1),行前路C4,5椎间盘切除、C4,5椎间植骨钢板内固定术。将压敏片置于关节突关节内,在脊柱三维运动试验机上测量0载荷和2N·m载荷下,后伸、左右侧弯、左右旋转过程中关节突关节内压力的变化。结果颈椎前路手术后,邻近节段关节突关节内的压力增加,以后伸和左右旋转时最为明显,差异有显著性意义(P<0.05)。结论颈椎前路短节段植骨融合术后,邻近节段关节突关节内压力明显增加,可诱发邻近节段关节突关节的退变,从而引起相应的病症。     

原发性股骨近端溶骨性骨缺失的修复重建

目的总结和分析股骨近端原发性溶骨性骨缺损的手术修复方法。方法自1997～2003年我科共收治股骨近端原发性溶骨性骨缺损36例。根据肿瘤的性质及大小分别采用病灶刮除 自体(异体)皮松质骨植入8例；病灶刮除 自体(异体)皮松质骨 自体缝匠肌髂骨瓣复合植入 内固定术22例；病灶刮除 骨水泥填充 内固定5例；瘤段切除 人工双动股骨头置换1例。结果术后随访12～54个月，平均24个月，仅1例骨巨细胞瘤复发，关节功能评分33例优，3例良。结论根据肿瘤的性质和股骨近端骨缺损大小采取不同手术方式进行了病灶清除及功能重建，是一套有效的重建股骨近端骨缺损的方案。     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

18例距骨后突内侧结节骨折的诊断与治疗

距骨后突内侧结节（PMTr）骨折一直被认为是一种罕见骨折。我院1993—2002年共收治18例PMTT骨折患者，现将临床资料总结如下。     

儿童跟骨动脉瘤样骨囊肿:病例报告及文献分析

[目的]跟骨动脉瘤样骨囊肿是一种少见病，本文报告了1例儿童跟骨动脉瘤样骨囊肿患者。[方法]本文结合文献回顾性分析了跟骨动脉瘤样骨囊肿患儿的临床、影像学及组织病理学表现。[结果]肿物累及右侧跟骨，经肿物刮除术和植骨术后恢复良好。组织病理学检查确诊为右侧跟骨动脉瘤样骨囊肿。随访2年无复发。[结论]跟骨动脉瘤样骨囊肿是一种少见病，对于单纯的动脉瘤样骨囊肿，肿物刮除术和植骨术是有效的治疗方法。     

闭合复位小切口支撑植骨治疗跟骨骨折

目的观察闭合复位小切口支撑植骨治疗跟骨骨折的临床效果。方法 2008年6月～2009年12月,采用手法结合撬拔复位骨折,自跟骨外侧小切口骨折塌陷区支撑植骨治疗跟骨关节内骨折25例。结果本组病例术后获平均13.5个月（8～19个月）的随访,X线片显示Bohler角、Gissane角及Peries角均恢复。根据Maryland足部功能评分法,优18例,良5例,可2例,优良率92%。结论闭合复位小切口支撑植骨治疗跟骨骨折临床疗效满意。     

针灸治疗骨痹1例

患者，男，38岁，2007年3月8日初诊。主诉：患者于2001年初春时觉脊背酸痛，倦怠乏力，继而胸背渐趋前倾姿态，弯背则舒，挺胸或伸腰受限，且脊背疼痛加剧，不能仰卧，症状日渐加重。经汕头某医院X线和CT摄片检验确诊为类风湿性脊椎炎，经用激素封闭治疗（包括服西药）、理疗、牵引和服中药等长期治疗，亦难以控制症状。病情有增无减，苦恼至极，经人介绍转诊于余处。现症：精神困倦，面色少华，脊椎疼痛牵引至胁，脊椎中段棘突凸出较为明显并疼痛，椎体不平，背屈则舒，     

驳骨黄水在皮肤破损骨折正骨中应用的临床观察

目的:观察驳骨黄水在皮肤破损骨折正骨中应用的疗效。方法:选择皮肤破损骨折正骨患者162例,骨折患者手法整复后,外敷驳骨黄水浸湿的纱块,然后包扎及小夹板固定。观察患者有无局部和全身过敏反应及毒性反应等毒副作用,以及患肢创面愈合、疼痛、肿胀、瘀斑消失、骨折愈合等情况。结果:显效147例,有效10例,差5例,无效0例。创面愈合(10±2)天,疼痛消失(3±2)天,肿胀消失(7±2)天,瘀斑消失(7±2)天,骨折愈合2～10周。122例轻度皮肤破损患者创面愈合且无炎性反应;35例中度皮肤破损患者中10例有轻度炎性反应,适当口服抗生素治疗而愈;5例重度皮肤破损患者有较明显炎性反应,需静脉滴注抗生素治疗而愈;未出现无效病例,162例患者骨折最终全部愈合。结论:驳骨黄水在皮肤破损骨折正骨中使用安全有效,无毒副作用,且可明显改善患肢疼痛、肿胀、瘀斑症状。